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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 05/06/2025

Please join us for Acne Global Education day on June 7th. We have an all-star cast lined up and it is going to be an outstanding session on everything acne. For more and to register: www.global-dermatology.com/en/events/ac...

global-dermatology.com

ACNE | Global Education Day 2025

ACNE Global Education Day 2025: join top experts online for clinical insights, treatment updates, and expert discussions at global-dermatology.com.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 13/03/2025

Some more evidence from a meta-analysis of 6 RCTs to support that subdermal implants (i.e. Nexplanon) are more likely to cause acne than hormonal IUDs (OR 2.21). Something to keep in mind for those concerned about acne who otherwise don't have strong preferences. pubmed.ncbi.nlm.nih.gov/40069520/

pubmed.ncbi.nlm.nih.gov

Subdermal implants vs. levonorgestrel intrauterine devices outcomes in reproductive-aged women: a systematic review and meta-analysis - PubMed

PROSPERO ID: CRD42024516472.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 12/03/2025

Avoid: ❌ La Roche-Posay Effaclar Duo Dual Action Acne Tx ❌ Walgreens Acne Control Cleanser ❌ Proactiv Emergency Blemish Relief Cream BPO ❌ Proactiv Skin Smoothing Exfoliator ❌ SLMD Benzoyl Peroxide Acne Lotion ❌ Walgreens Tinted Acne Treatment Cream ❌ Zapzyt Acne Tx Gel

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 12/03/2025

4. I'm thankful that we have been having this conversation over the past year to ensure the continued safe use of this foundational acne treatment. I look forward to continuing to work with others on this issue so that we can provide the highest quality care for those with acne.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 12/03/2025

This aligns with generally reassuring epidemiologic data supporting the safety of benzoyl peroxide containing products (pubmed.ncbi.nlm.nih.gov/39002561/; pubmed.ncbi.nlm.nih.gov/38950699/; pubmed.ncbi.nlm.nih.gov/38909658/;

pubmed.ncbi.nlm.nih.gov

Benzoyl peroxide for acne treatment is not associated with an increased risk of malignancy: A retrospective cohort study - PubMed

Benzoyl peroxide for acne treatment is not associated with an increased risk of malignancy: A retrospective cohort study

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 12/03/2025

3. It appears the FDA agrees that the clinical risk is minimal, even for products being recalled (hence why recall is at the retail rather than consumer level). "Even with daily use for decades, the risk of developing cancer because of exposure to benzene found in these products is very low."

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 12/03/2025

2. As we found in our recent @JAMADerm study, there are likely opportunities for manufacturers to re-evaluate their formulation, production, and distribution practices to achieve the goal of minimizing the formation of benzene in benzoyl peroxide products. jamanetwork.com/journals/jam...

jamanetwork.com

The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products

This quality improvement study examines the effects of formulation on benzene levels detected in over-the-counter benzoyl peroxide products.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 12/03/2025

1. The vast majority of products were found to have undetectable or extremely low levels of benzene, which is reassuring. It also highlights that our goal should be insignificant levels of benzene in these products as most manufacturers are able to achieve this goal.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 12/03/2025

🚨 News Alert 🚨 The FDA just released an important update regarding benzene in benzoyl peroxide products (www.fda.gov/drugs/drug-s...). See below for my thoughts and products to avoid:

fda.gov

Recalls small number of acne products for benzene contamination

Voluntary recalls of acne products after FDA testing finds small number of proudcts with elevated levels of benzene

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 07/03/2025

And finally, it is important to consider risks of benzoyl peroxide containing products in the context of other alternative acne treatments that would be required if we avoid these products (and then also topical antibiotics). 8/8 pubmed.ncbi.nlm.nih.gov/38909658/

pubmed.ncbi.nlm.nih.gov

Benzene in benzoyl peroxide-how worried should we be? - PubMed

Benzene in benzoyl peroxide-how worried should we be?

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 07/03/2025

That being said, I believe we do have opportunities to improve formulation, production, and distribution practices to maximize the safety of benzoyl peroxide products. pubmed.ncbi.nlm.nih.gov/39937513/ 7/8

pubmed.ncbi.nlm.nih.gov

The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products - PubMed

The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 07/03/2025

Finally, there are the general limitations of FAERS and the small sample size. Ultimately, we will need further input from the FDA and prospective studies, but given currently available data, I think the likelihood of clinically meaningful risk is low. youtu.be/TYcZXjCzt8Q 6/8

youtu.be

Benzene (carcinogen) in benzoyl peroxide? Should we be worried? | Dermatologist explains

YouTube video by John Barbieri, MD

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 07/03/2025

There also doesn't appear to be any signal for leukemia/lymphoma, which are the main malignancies one might expect with benzene exposure based on prior studies. 5/8

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 07/03/2025

From a face validity standpoint, it is unlikely that BPO products have a 100x greater risk of lung cancer than smoking. If this were true, we should have easily observed it in our cohort studies. 4/8 pubmed.ncbi.nlm.nih.gov/39002561/

pubmed.ncbi.nlm.nih.gov

Benzoyl peroxide for acne treatment is not associated with an increased risk of malignancy: A retrospective cohort study - PubMed

Benzoyl peroxide for acne treatment is not associated with an increased risk of malignancy: A retrospective cohort study

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 07/03/2025

Additionally, 100% of the reports are for Proactiv products, who reportedly are being sued about this issue, which again raises concerns about reporting bias. These lawsuits were likely started prior to March 2024 and could have influenced 2023 data 3/8 www.prnewswire.com/news-release...

prnewswire.com

Makers of Proactiv, Clearasil, and Others Sued in Benzoyl Peroxide Acne Product Class Action

/PRNewswire/ -- Wisner Baum filed multiple class actions alleging several companies sold benzoyl peroxide (BPO) acne products without warning consumers that...

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 07/03/2025

Most worrisome, 22/23 of the identified case of malignancy are from 2023-2024, with only 1 reported from 2019-2022 (they don't evaluate earlier years). This is very concerning for reporting bias, potentially influenced by 3rd parties. Notably, you don't see a pattern like this for adapalene. 2/8

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 07/03/2025

A new report on the potential relationship between benzene and benzoyl peroxide was just released in @theJIDJournal. While I applaud continued efforts to address this important topic, I have some serious concerns with this study. 1/8 www.sciencedirect.com/science/arti...

sciencedirect.com

A Disproportionality Analysis on Benzoyl Peroxide and its Risk of Malignancy using the FDA Adverse Event Reporting System

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 07/03/2025

I don't even know why we bother writing appeals these days. It seems like the reviewers do not even engage with the content of the letter and just repeat the same rationale as the original denial. I'd like to just skip and go straight to next step to avoid more delays :/

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 06/03/2025

Yes, they likely do work! The effect is relatively mild, but they actually have outperformed even benzoyl peroxide in a couple of head to head trials. It is important to get a model with adequate fluence/irradiance.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 05/03/2025

There is growing interest in the role of home LED therapy for acne. In this systematic review and meta-analysis in JAMA Derm, we examine the evidence base for this treatment (TL/DR: it appears to have reasonable efficacy for mild acne): www.massgeneralbrigham.org/en/about/new...

massgeneralbrigham.org

Researchers Find At-Home LED Devices for Acne Treatment Are Safe and Effective for Skincare Routines | Mass General Brigham

In a review and meta-analysis of previous studies, researchers from Mass General Brigham found red and/or blue light devices were effective in treating mild-to -moderate acne.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 26/02/2025

Sherry Ershadi, an amazing research fellow in our lab this year, has put together these incredible acne/rosacea patient handouts. Feel free to use them if you find them helpful: barbierilab.bwh.harvard.edu/educational-...

barbierilab.bwh.harvard.edu

Educational Handouts – Barbieri Lab

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 26/02/2025

Lately, we've seen a lot of discussion about the potential risk of benzoyl peroxide products breaking down into benzene. In this letter, we discuss some of the limitations with respect to the methodology and framing of the recent Kucera et al. article in the JID: www.jidonline.org/article/S002...

jidonline.org

The need for transparency and careful messaging regarding the potential for benzoyl peroxide products to form benzene

We read with interest the article by Kucera et al. (Kucera et al. 2024) and agree that this topic is of tremendous importance given the ubiquitous use of benzoyl peroxide (BPO) for acne and other skin...

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 19/02/2025

Minocycline-MR 40mg was recently FDA approved for rosacea. In this video, I will review the clinical trial data and share my thoughts on where it fits among our existing treatment options: #rosacea #minocycline #emrosi youtu.be/103ncqVznGk

youtu.be

How good is the new Minocycline-MR (Emrosi) for rosacea | Dermatologist explains

YouTube video by John Barbieri, MD

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 12/02/2025

Also important to keep in mind that while we do want to identify strategies to reduce benzene to as close to zero as possible, I think these benzoyl peroxide products are still generally safe to use based on the data we have available: youtu.be/LSylzH_ikU8

youtu.be

Will using benzoyl peroxide for acne cause cancer? | Dermatologist explains latest studies

YouTube video by John Barbieri, MD

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 12/02/2025

Excited to share work with @labmuffin.com, Courtney Rubin, and James Pham, identifying how formulation characteristics might be associated with benzene levels in benzoyl peroxide products. Some helpful hypotheses to guide future product development. jamanetwork.com/journals/jam...

jamanetwork.com

The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products

This quality improvement study examines the effects of formulation on benzene levels detected in over-the-counter benzoyl peroxide products.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 06/02/2025

In this latest video, I review common reasons why isotretinoin is not working and how to address these clinical scenarios: youtu.be/gEc2qxdEH6Q

youtu.be

Why Accutane (isotretinoin) isn’t working | Dermatologist and acne expert explains

YouTube video by John Barbieri, MD

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 28/01/2025

Of note it's not always lower, so still worth looking at both, but often it is lower and it can be more convenient since don't have to go to pharmacy. Easy to e-prescribe from the EMR and probably something we should consider using more often. PS: JAMA Derm is the highest impact #DermSky journal 😜

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 27/01/2025

We often consider GoodRx to reduce out-of-pocket costs. In this @JAADjournals study, we find that @costplusdrugs frequently has lower prices for derm drugs (and the mail order aspect may be more convenient). Another good option to help with affordability. pubmed.ncbi.nlm.nih.gov/39863169/

pubmed.ncbi.nlm.nih.gov

Comparing Prescription Drug Saving Platforms for Dermatology: A Cost Analysis of Mark Cuban Cost Plus Drugs, GoodRx, and Amazon RxPass - PubMed

Comparing Prescription Drug Saving Platforms for Dermatology: A Cost Analysis of Mark Cuban Cost Plus Drugs, GoodRx, and Amazon RxPass

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 22/01/2025

Just out in @JAMADerm, we describe the psychometric properties of the 1-item ACORN Patient Global Assessment, which correlates well with the CASS IGA and also is highly responsive to change. This can be particularly useful for online surveys/assessments. jamanetwork.com/journals/jam...

jamanetwork.com

Validation of the ACORN Patient Global Assessment

This survey study evaluates the measurement properties for acne severity of the Acne Core Outcome Research Network (ACORN) patient global assessment.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 22/01/2025

Should we start with spironolactone or doxycycline for women with acne? Check out my breakdown of the FASCE trial here: youtu.be/zRbPfSCn9Ow

youtu.be

Spironolactone or oral antibiotics? Which is best? | FASCE Trial | Dermatologist explains

YouTube video by John Barbieri, MD

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 15/01/2025

This study has limitations related to the observational design, these data add to the literature regarding long-term outcomes after treatment with isotretinoin for acne, which can help to guide patient counseling and clinical decision making.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 15/01/2025

4. Female patients were more likely to have acne recurrence. Given the effect of cumulative dose (#2), it may be worth targeting higher cumulative dose/more months clear prior to stopping in female patients who prioritize minimizing recurrence.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 15/01/2025

3. Notably, after stratifying or adjusting for cumulative dose, daily dose (e.g. low vs high) was not associated with differences in rates of recurrence. These results support the opportunity to individualize treatment regimens to patient goals and that lower daily dose regimens can be effective.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 15/01/2025

2. Increasing cumulative dose was associated with reduced recurrence, though this effect was lost at >220mg/kg. While higher cumulative dosages are associated with reduced recurrence, it appears there is a limit and it is important to be thoughtful about benefits vs risks (e.g. long-term dryness).

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 15/01/2025

1. About 35% went on to use a topical acne treatment and about 20% went on to use a systemic medication (8% repeat isotretinoin). It is important to set appropriate expectations that while isotretinoin typically causes a 'remission' and reduced long-term activity, it is not a 'cure' for everyone.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 15/01/2025

Using MarketScan, we identified ~20,000 individuals treated with a first course of isotretinoin for at least 4 months (mean course duration 6 months and estimated cumulative dose 130mg/kg) and who had at least 1 year of follow-up data available. Some of the main takeaways:

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 10/01/2025

Do we really need to check frequent labs for isotretinoin? In this video, I go through the evidence about why we likely aren't getting much value from our current approach and even make a case for no monitoring: youtu.be/UpsW1iN9FRw

youtu.be

Does Accutane (isotretinoin) require lab monitoring? | Dermatologist and acne expert explains

YouTube video by John Barbieri, MD

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Reposted by John Barbieri, MD, MBA

Tasha Tolliver @tashat.bsky.social · 23/12/2024

Some of the best evidenced-based info on acne treatment right here! @drjohnbarbieri.bsky.social #DRESSsyndrome #acnetreatment

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 22/12/2024

Want to learn more about which are the best oral antibiotics for the treatment of acne, including the relative role of doxycycline, minocycline, sarecycline (Seysara), trimethoprim-sulfamethoxazole (Bactrim), amoxicillin, and azithromycin, among others? Check out this video: youtu.be/RgMXi92UjnQ

youtu.be

What are the best antibiotics for acne | Dermatologist and acne expert explains

YouTube video by John Barbieri, MD

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 19/12/2024

Catch up on some of the biggest topics, studies, and new medications for acne in my latest year-in-review video: youtu.be/vxqxzDYGSsg

youtu.be

Catch up on the biggest acne developments of 2024: Year in Review | Dermatologist Explains

YouTube video by John Barbieri, MD

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 09/12/2024

These results are important as there have been concerns whether certain medications, such as isotretinoin, may be associated with fracture risk. Understanding the relative effect of acne itself is helpful to contextualize other studies.

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John Barbieri, MD, MBA @drjohnbarbieri.bsky.social · 09/12/2024

In JAAD, we find evidence that acne may be a risk factor for fractures. This aligns with evidence that acne is associated with low vitamin D levels or might be related to pleiotropy or systemic inflammation www.sciencedirect.com/science/arti...

jaad.org

DEFINE_ME

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